Health

As Doctors Leave Syria, Public Health Crisis Looms

Refugees fill cans with water inside a camp in Baalbek, Lebanon, for Syrians who have fled the fighting in their country.

The death toll in Syria's ongoing civil war may now be as high as 100,000. As the violence mounts, another emergency is looming: a public health crisis across the region.

That's the conclusion of a new study published by the British medical journal The Lancet. Syria's health care system is near collapse. Outbreaks of disease are on the rise in the country, and refugees sheltered beyond the border are also at great risk.

One medical clinic in a poor neighborhood in Beirut is always busy. The two-story building is up a narrow street of cinder-block homes. Syrian refugees have moved in, adding to the crowding and the caseload, Dr. Abdul Kader Abbas says. He says he's treated 758 Syrian families here — many already sick when they arrived in this densely packed neighborhood.

"With the additional numbers," Abbas says, "we are afraid that any disease could spread easily in such circumstances." That's the same warning spelled out in the latest Lancet report.

Seventy percent of Syria's medical professionals have fled the country. Public health researchers Dr. Adam Coutts and Dr. Fouad Fouad say there has been a dramatic rise in communicable disease.

For example, Coutts says, there were 7,000 cases of measles in northern Syria in the past few months after a vaccination program was disrupted by war, and the list is growing to include TB, leishmaniasis, typhoid and cholera, which will come up during the summer months.

Leishmaniasis is spreading so fast among the displaced people inside of Syria that it is now called the "Aleppo boil" — for the running skin sores transmitted by sand fleas. Fouad says with the collapse of Syria's health care system, many Syrians have not had any medical care or medicine for more than two years.

When you consider chronic diseases like diabetes, Type 1 and 2, and cancer, Fouad says, you start to see that more people are dying of disease rather than war.

Disease moves easily across boundaries along with the refugees. Coutts and Fouad warn this could lead to a public health crisis for the entire region. By the end of this year, the Syrian refugee population is expected to reach more than 3 million.

In Jordan, the patient load in hospitals has jumped 250 percent in the past five months. Lebanon's health system is under strain with more registered refugees than any of its neighbors.

"With this huge influx of refugees now in Lebanon," Fouad says, "the number will come to change the whole system."

One expected change is in the school system. U.N. officials estimate that when school starts in the fall, Syrians will outnumber Lebanese kids in the country's public schools. That worries Hayda Mohammed Al Jeeshi, the nurse at the health care center.

She says many Syrian kids missed childhood vaccinations before they fled to Lebanon and that puts Lebanese children at much greater risk. The measles outbreak that started in northern Syria is now showing up among the refugee community in Lebanon.

Scrambling to care for one of the world's largest refugee populations is another burden of the Syrian war. The U.S. government has upped its contribution to host countries to more than $800 million, with an additional $300 million pledged this month for food, shelter and health care.

"Diseases don't care whether you're for Assad, or against Assad, or uninterested in politics," says Anne Richard, the U.S. assistant secretary of state for refugees, who was in Lebanon this week. "It strikes everyone, as an equal opportunity."

We turn now to Syria, where the death toll from that country's civil war may be as high as 100,000. And as the violence mounts, it carries with it another crisis - a public health crisis that imperils the entire region. That's the conclusion of a new study published by The Lancet, the British medical journal. Syria's health care system is near collapse. Outbreaks of disease are mounting and Syrian refugees in neighboring countries are also at great risk. NPR's Deborah Amos reports from Beirut.

DEBORAH AMOS, BYLINE: The medical clinic in this poor neighborhood in Beirut is always busy. The two-story building is up a narrow street of cinderblock homes. Syrian refugees have moved in, adding to the crowding and the caseload, says Dr. Abdul Kader Abbas. He now treats 758 Syrian families. Many were already sick when they arrived in this densely packed neighborhood.

DR. ABDUL KADER ABBAS: (Through Translator) And now with the additional numbers, yes, we are afraid that any disease could spread easily in such circumstances.

AMOS: That is the warning spelled out in the latest Lancet report. Dr. Adam Coutts and Syrian doctor, Fouad Fouad, both pubic health researchers, say 70 percent of Syria's medical professionals have fled the country. There is a dramatic rise in communicable disease. For example, measles: 7,000 cases in northern Syria in the past few months after a vaccination program was disrupted by war, says Coutts, and the list of diseases is growing.

DR. ADAM COUTTS: TB, leishmanaisis, typhoid, cholera, which will come up during the summer months.

AMOS: Leishmaniasis is spreading so fast among the displaced inside Syria that it's now called Aleppo Boil, for the running skin sores transmitted by sand fleas. Dr. Foaud says with the collapse of Syria's health care system, many Syrians haven't had any medical care or medicines for the past two years.

DR. FOAUD FOAUD: Also, we think about chronic disease, like diabetes, type 1 and 2, also cancer. And I think that maybe it starts that people die because of diseases more than because of war.

AMOS: Disease easily moves across borders along with the refugees. Coutts and Foaud warn this could lead to a public health crisis for the entire region. The refugee population is expected to reach more than three million by the end of this year. In Jordan, the patient load in hospitals has jumped 250 percent in the past five months. Lebanon's health system is under strain with more registered refugees than any of its neighbors, says Dr. Foaud.

FOAUD: With this, you know, huge influx of refugees now in Lebanon, the number will come to change the whole system in Lebanon.

AMOS: One expected change is in the school system. U.N. officials estimate that when school starts in the fall, Syrians will out number Lebanese kids in the country's public schools. And that worries Hayda Mohammed al Jeeshi, the nurse at the health care center. She says many Syrian kids missed childhood vaccinations before they fled to Lebanon and that puts Lebanese children at much greater risk.

(SOUNDBITE OF HEALTH CARE CENTER)

AMOS: Are you seeing a rise in child hood diseases among the Syrians?

HAYDA MOHAMMED AL JEESHI: The measles, yes.

AMOS: The measles outbreak that started in northern Syria is now showing up among the refugee community here. It is another burden of the Syrian war as host countries scramble to care for one of the world's largest refugee populations. The U.S. government has upped its contribution to more than $800 million, with an additional $300 million pledged this month for food, shelter and health care. Ann Richard, assistant secretary of state for refugees was in Lebanon this week.

ASSISTANT SECRETARY ANN RICHARD: Diseases don't care whether you're for Assad or against Assad, or uninterested in politics. It strikes everyone as an equal opportunity.

AMOS: As the war grinds on in Syria, rebels fighting President Bashar al Assad's loyalists, the number of Syrians fleeing across borders is expected to rise, and so is the danger of disease. Deborah Amos, NPR News, Beirut.